What If We Already Knew How to Tackle Some of America's Thorniest Problems?

Do you wish we knew a way to improve the health of at-risk mothers, and make it likelier that their kids will be safe at home and ready to succeed when they enter school?
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Do you wish we knew a way to improve the health of at-risk mothers, and make it likelier that their kids will be safe at home and ready to succeed when they enter school? And, while we're wishing, how about if this magic bullet actually saved more money in the long run than it cost in the short run?

It's not magic; it's the Nurse-Family Partnership, a home visiting program with 30 years of research behind it - and which, thanks to strong backing from philanthropy and government now reaches 24,000 first-time pregnant low-income mothers. It's Youth Villages, which provides supports that enable troubled kids to stay with family members rather than be placed in a residential facility, producing much better outcomes at lower cost.

In a growing number of areas - whether it's reducing teen pregnancy or helping those at risk of type 2 diabetes keep from getting the disease or finding ways for chronically homeless individuals to finally get off the streets into a home of their own - we increasingly know what works. The challenge is to convert this knowledge into action.

Last October, in my TEDx talk, I made the case that in a time of fiscal crisis, it's more urgent than ever to invest in what works. This shouldn't be a partisan issue. Regardless of whether we believe that government ought to do more or less, it makes sense that if we've already committed to spend $100 million or $500 million or many billions to try to address a problem, and there's research that tells us what it is effective, we should invest in what works rather than use the peanut-butter approach and spread the money around.

The most common response I received from people who heard my TEDx talk was "Really? This is just common sense. Of course money ought to invest in what works." But common sense alone isn't causing people to demand change. Indeed, the very fact that there is such an obvious answer - and it isn't being done - leads people to throw up their hands and grumble some more about government.

I know, "Invest in evidence-based programs!" is never going to show up on a bumper sticker. It sounds technocratic. It is technocratic - but it will make the difference in whether kids get a real education, adults find jobs, and people avoid preventable health problems.

Over the last few months, we see glimmers that the evidence-based approach is spreading. The President's 2014 budget would shift more existing resources into proven programs, and step up federal evaluation efforts to learn what's effective. Republic Senator Rob Portman from Ohio has championed the use of evidence-based programs to help integrate returning prisoners back into the community and "pay for success" strategies in workforce development and other areas. Democratic Senator Mary Landrieu from Louisiana has recently called for federal programs to "focus on outcomes rather than simply on compliance", invest in programs with the strongest evidence of effectiveness, and support the development and rigorous evaluation of promising, innovative interventions.

We're unlikely to see a grassroots movement spring up behind evidence-based programs in the abstract, but we have indeed seen such movements around issues that hit home. When in the late 1980s and early 1990s AIDS activists took to the streets to press for more effective ways to prevent and treat the disease, they were indeed a constituency for what works. In communities across the country, when parents come together to demand better schools, they are part of the "what works" agenda. Results for America, a recently formed group committed to building this constituency, hosted a meeting in Washington, DC, in April that began to lay the groundwork for pursuing this agenda more aggressively at the federal, state, and local levels.

But the moment feels ripe for change. The pressures on government budgets, the growing coherence of the "what works" approach, the increased availability of data on what is working, and the emerging voices of activists who see the what works movement as a way to address some of the country's most important problems - all these give me hope that we will try to figure out what the evidence tells us and direct resources away from the uncertain and unproven to what works.

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